Provider Demographics
NPI:1184860660
Name:BLACKFOOT EMS, INC.
Entity Type:Organization
Organization Name:BLACKFOOT EMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:G
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:EMTB
Authorized Official - Phone:406-677-4236
Mailing Address - Street 1:PO BOX 41
Mailing Address - Street 2:
Mailing Address - City:SEELEY LAKE
Mailing Address - State:MT
Mailing Address - Zip Code:59868-0041
Mailing Address - Country:US
Mailing Address - Phone:406-677-3158
Mailing Address - Fax:406-677-3158
Practice Address - Street 1:2430 HIGHWAY 83
Practice Address - Street 2:
Practice Address - City:SEELEY LAKE
Practice Address - State:MT
Practice Address - Zip Code:59868
Practice Address - Country:US
Practice Address - Phone:406-677-3158
Practice Address - Fax:406-677-3158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-05
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT011003075Medicare PIN